MD Update Issue 153

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #153 WWW.MD-UPDATE.COM

Individualized Care.

Built to Last.

VOLUME 14 • #4 • September 2024

Kentucky Bone & Joint Surgeons Excels as an Independent Orthopedics and Sports Medicine Practice

by Attending to Details and Providing Customized Care ALSO IN THIS ISSUE SPORTS MEDICINE AND ORTHOPEDIC SURGERY AT ARH NONSURGICAL ORTHOPEDICS AT BAPTIST HEALTH LOUISVILLE NEW APPROACH TO SHOULDER SURGERY AT CHI SAINT JOSEPH LONDON TRACKSIDE SPORTS MEDICINE

BY NORTON ORTHOPEDICS HIGH-FLYING HIP REPLACEMENT SURGEON AT UOFL HEALTH

Experience Matters.

Orthopedics Team

Jeeshan Ali Faridi, MD

Collin Ball, DPM

Patrice Beliveau, MD

Anup Chattha, MD

Vincent DePalma, DO

Adam Franson, DO

Kevin Magone, MD

Sanjiv Mehta, MD

James Rollins Jr., MD

Frank Taddeo, MD

The board-certified physicians at CHI Saint Joseph Medical Group — Orthopedics are proud to offer comprehensive orthopedic care.

When your quality of life has been affected by a bone or joint disorder, the orthopedic team at CHI Saint Joseph Medical Group is ready to get you back on your feet. With over 50 years of combined experience, our board-certified and fellowship-trained surgeons are passionate about their high standards of care.

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THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

Editorial Calendar

2024 ISSUE #154 (October) CANCER CARE Hematology, Oncology, Plastic Surgery, Radiology, Radiation

ISSUE #155 (December) IT’S ALL IN YOUR HEAD ENT, Mental Health, Neurology, Neuroscience, Ophthalmology, Pain Medicine, Psychiatry

2025 ISSUE #156 (February) HEART & LUNG HEALTH Cardiology, Cardiothoracic Medicine, Cardiovascular Medicine, Pulmonology, Sleep Medicine, Vascular Medicine, Bariatric Surgery

ISSUE #157 (April) INTERNAL & EXTERNAL SYSTEMS Dermatology, Endocrinology, Gastroenterology, Geriatric Medicine, Internal Medicine, Integrative Medicine, Infectious Disease Medicine, Lifestyle Medicine, Nephrology, Urology

ISSUE #158 (June) WOMEN & CHILDREN’S HEALTH OB/GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology

ISSUE #159 (September) MUSCULOSKELETAL HEALTH Orthopedics, Physical Medicine & Rehabilitation, Sports Medicine, PT/OT

ISSUE #160 (October) CANCER CARE To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com

Hematology, Oncology, Plastic Surgery, Radiology, Radiation

ISSUE #161 (December) IT’S ALL IN YOUR HEAD ENT, Mental Health, Neurology, Neuroscience, Ophthalmology, Pain Medicine, Psychiatry Editorial topics and dates are subject to change

LETTER FROM THE EDITOR/PUBLISHER

Welcome to the Orthopedics and Sports Medicine issue of MD-Update September is a great time of year for sports fans. Baseball and football are in full swing with basketball just around the corner. This year we also had the Summer Olympics. I wasn’t planning to watch much of the Olympics, but the women’s gymnastics hooked me in and then swimming and track and field. I thought the size and physiques of the athletes were incredible, particularly the water polo guys.

Standing next to, or behind, all those athletes are the orthopedic and sport medicine doctors along with their parents, athletic trainers, rehab specialists, and coaches. In this issue of MD-Update, we’re proud to introduce and write about some of those doctors, many of whom played sports prior to medical school.

I’ve written about it before, but please allow me to repeat a little personal history. I was born in Baltimore and grew up on the Eastern Shore of Maryland, on an island in the Chesapeake Bay. Back in the 1960s and 70s, Baltimore Oriole baseball was the world to me and my family, and Brooks Robinson was king of the hill. Long time Cincinnati Reds fans will sadly remember the 1970 World Series as the ten days when the sports world saw what Oriole fans knew all along, that Brooks Robinson was the greatest third baseman in baseball.

I got to meet Brooks Robinson in person when the radio station where I worked in Ocean City, Maryland, sponsored a Brooks Robinson Clinic after he had retired from playing. He was kind, gracious, and very generous with his time and energy to the kids who showed up and to the parents who were in awe that their boys were on the same baseball field as Brooks Robinson.

Brooks Robinson passed away on September 26, 2023. There is a tremendous video of Brooks Robinson highlights on YouTube. When I watch it, I get chills and emotions from my childhood.

I don’t think I’m alone with how childhood memories of sports moments touch me. Such is the power of sports for those who played them, watched them, cheered for them, and suffered for them.

Every one of the orthopedic and sports medicine doctors that I spoke with for this issue said that the gratitude they receive from their injured athlete patients, and from nonathletes, motivated them to do their best, helping people get back in the game, doing what they do, living their lives to the fullest.

Next Up! The MD-Update editorial calendar for 2024 and 2025 is on the preceding page. Take a look at it. Find your specialty. If you don’t see it, reach out to me and let me know what I’m missing.

We’re always looking for a good story. I’m sure you have one to tell.

Until next time, all the best,

Gil Dunn Editor/Publisher MD-Update

2 MD-UPDATE

SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax

MD-UPDATE MD-Update.com Volume 14, Number 4

ISSUE #153

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COVER PHOTOGRAPHY BY PAUL MARTIN

10 I ndividualized Care.

Built to Last.

CONTENTS

Kentucky Bone & Joint Surgeons Excels as an Independent Orthopedics and Sports Medicine Practice by Attending to Details and Providing Customized Care

ISSUE #153

4 HEADLINES

SPECIAL SECTION:

29 MENTAL WELLNESS

6 ACCOUNTING

14 ORTHOPEDICS/HIP REPLACEMENT 18 ORTHOPEDICS/SPORTS MEDICINE/SHOULDER SURGERY 20 ORTHOPEDICS/SPORTS MEDICINE 24 ORTHOPEDICS/SPORTS MEDICINE AT ARH 26 ORTHOPEDICS/NONSURGICAL ORTHOPEDICS

31 NEWS

7 LEGAL 8 FINANCE 10 COVER STORY

14 ORTHOPEDICS/ HIP REPLACEMENT

18 ORTHOPEDICS/ SPORTS MEDICINE/ SHOULDER SURGERY

20 ORTHOPEDICS/ SPORTS MEDICINE

24 ORTHOPEDICS/ SPORTS MEDICINE AT ARH

26 ORTHOPEDICS/ NONSURGICAL ORTHOPEDICS ISSUE #153 3

Headlines

Lexington Medical Society Foundation Awards Grants

Lexington area medical and health-oriented nonprofits receive funds from annual LMSF golf tournament LEXINGTON The Lexington Medical Society

requests and distributed over $22,500 to fourteen nonprofit healthcare organizations.

LMS Foundation Golf Tournament chair John Collins, MD, affirmed the Foundation’s mission “to improve the health of our community through support of Lexington-area medically related nonprofit organizations, medical stuLMS Foundation board members include Gil Dunn, Jane Chiles, Angela Dearinger, dents, and physiMD, LMS president, Bill Farmer Jr., Susan Neil, MD, John Collins, MD, John Maher, cian leadership and John DeWeese, Alicia Jordan, and Hunt Ray, LMSF treasurer. (Not pictured is David wellness programs.”

Bensema, MD, who attended virtually.)

Organizations Foundation’s annual golf tournament, on May 29, 2024, raised over $20,000. On August 5, Foundation board members evaluated grant

LEXINGTON MEDICAL SOCIETY Physicians taking care of the community since 1799

The principal voice & resource for Central Kentucky physicians Physician Wellness Program 24/7 Medical Call Center Legislative advocacy in partnership with the Kentucky Medical Association Oct. 16 Dinner Social & Past President’s Recognition Financial Independence & General Wealth Pathway

For more information visit

lexingtondoctors.org or call (859) 278-0569

4 MD-UPDATE

Nov. 6 Dinner Social & Augmented Intelligence Symposium Medical Use of AI, Ethical & Legal Considerations PHOTOS PROVIDED BY LEXINGTON MEDICAL SOCIETY

that received funds were Baby Health Services, which provides medications and immunizations at no cost to uninsured children in Fayette and surrounding counties; Camp Horsin’ Around, a camp for children with compromised health or special needs; Children’s Advocacy Center, which provides comprehensive medical and mental health examinations for child victims of sexual abuse in Fayette County; Chrysalis House, which assists women recovering from substance abuse with residential aid and oral health programs; The Explorium at the Lexington Children’s Museum, which provides educational activities for children while teaching about the human body; LMS Physician Wellness Program, which provides counseling services for active LMS physicians, UK residents, and medical students; McDowell House Museum, which hosts a summer camp for children that teaches health and medical procedures; Radio Eye, which addresses the information needs of people who are blind or disabled by providing 24/7 audio services such as reading local and regional newspapers, health periodicals, magazines, and programs on health; Lexington Hearing & Speech Clinic, which provides care for children 0-3 years old with hearing loss; Ronald McDonald House, which provides housing for families whose children are being treated in local medical facilities; Mission Health & Faith Pharmacy, which offers medical treatment such as insulin for low-income and uninsured adults; Surgery on Sunday, which provides free outpatient surgery for uninsured or low-income patients; Bluegrass Council of the Blind, which provides health services to the blind or visually impaired; and KY Diabetes Camp for Children, Camp Hendon, a summer camp for children with Type 1 diabetes.

For information on the Lexington Medical Society visit www.lexingtondoctors.org.

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Accounting

Navigating Value-Based Models for Healthcare Providers

BY ERIC RILEY, HEALTHCARE CONSULTING DIRECTOR

What is Value-Based Care?

The healthcare industry is experiencing a significant shift from traditional volume-based care to value-based care (VBC), which emphasizes patient outcomes and quality of care over the number of services provided. This transition aims to improve patient health, reduce healthcare disparities, and manage the escalating healthcare costs. The success of VBC depends on creating a collaborative environment where healthcare providers are incentivized to deliver the highest quality care, with payments directly linked to patient outcomes.

Understanding ValueBased Payment Models Value-based payment (VBP) models deviate from traditional fee-for-service models by reimbursing providers based on performance and patient outcomes rather than the volume of services. There are several types of VBP models, including but not limited to: • Pay-for-Performance: Providers receive bonuses for meeting quality metrics, such as reduced hospital readmissions or improved patient satisfaction scores.

• Bundled Payments: A single payment is made for all services related to a specific treatment or condition, promoting efficiency and coordination among providers.

• Shared Savings Program: Providers share in the savings achieved when they deliver care within a certain cost threshold

while meeting quality benchmarks. This VBP model offers a range of risk-based pathways that may allow providers to “lean into” value-based care initiatives. For example, if generated, “Upside Risk” payment arrangements reward a portion of the savings arrangement to the provider.

The provider shares no downside risk and can develop critical value implementation workflows while learning and transitioning to VBP model pathways.

• Capitation and Specialty Subcapitation: Often, the entire payment is a risk, where the payment is tied to the patient or the population, typically referred to as PMPM (per person per month). Providers receive a set amount per patient per month, regardless of the number of services provided, incentivizing preventive care and efficient resource use.

Challenges and Opportunities Implementing VBP models presents both challenges and opportunities for healthcare providers: 1. Challenges • Data Collection and Analysis: Providers need robust data capabilities to track and improve performance metrics.

• Risk-Based Contracting: Providers must understand and manage various forms of risk, including financial incentives and penalties.

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• Complexity of Models: Navigating different VBP models and contracts can be complex and resource-intensive.

2. Opportunities • Improved Patient Care: By focusing on quality, providers can prioritize preventative and targeted care, potentially improving patient outcomes and reducing the inappropriate need for costly treatments.

• Cost Reduction: Efficient care delivery can lead to significant cost savings, benefiting both providers and patients.

How to be Successful Successful implementation of value-based care requires a strategic and operational shift: • Leadership Commitment: Clear communication of leadership’s vision and goals of value-based care is crucial.

• Provider and Patient Engagement: Both providers and patients must be actively engaged in the transition, with providers involved in planning and implementation and patients educated about the benefits of value-based care.

• Data-Driven Decision-Making: Effective use of data analytics and performance metrics is essential for tracking progress and driving continuous improvement.

As healthcare costs continue to rise, the shift towards value-based payment models will likely accelerate. Providers who can deliver high-quality, cost-effective care will be well-positioned for success in this evolving landscape.

The transition to value-based care is a challenging but necessary step towards a more efficient and effective healthcare system.

To download a comprehensive guide with detailed insights on navigating value-based payment models, visit deandorton.com.

Legal

The FTC’s Non-Compete Rule What healthcare professionals need to know

BY K. ZOE JESSIE

Imagine you are one of the only practicing pediatric neurologists in the area. In 2011, you signed an employment contract with a practice that contained a non-compete agreement. In 2024, that organization no longer exists. It was acquired by a new organization and it’s not a good fit. Time to leave, right?

Wrong. Your new employer tells you the non-compete you signed in 2011 still restricts you from practicing in any related field within a 70-mile radius. You have two choices – (1) stay in your current situation, or (2) pick up your practice and move 71 miles away to continue your career.

Similar scenarios inspired the Non-Compete Clause Final Rule under 16 C.F.R. § 910 which the Federal Trade Commission (“FTC”) published on April 23, 2024. The Final Rule provided that “it is an unfair method of competition—and therefore a violation of Section 5 of the Federal Trade Commission Act—for persons to enforce or enter into non-compete clauses (“non-competes”) with workers on or after the Final Rule’s effective date.”

Federal Court Sets Aside Rule…For Now On August 20, 2024, after numerous legal challenges to the Rule, the U.S. District Court for the Northern District of Texas set aside the Rule on a nationwide basis. Now that there is a nationwide judicial ruling, the Rule will not go into effect on its original effective date of September 4, and the status quo regarding non-competes in Kentucky remains. However, since this is not a final decision, it is still helpful to review the Rule and what it may mean for anyone subject to these types of agreements.

Today, 35-45% of healthcare workers are contracted under non-compete clauses. Noncompetes grew in popularity with the expansion of hospital systems which have subsumed

private practices into those systems. Many hospitals and physician associations are non-profit tax-exempt entities, and precedent suggests that those entities are not subject to the FTC’s jurisdiction under Section 5. However, a tax-exempt entity can still be subject to the FTC’s jurisdiction based on the source of its income and who that income benefits.

Non-Competes: Why or Why Not? The FTC found, through studies and comments on the proposed ban, that non-competes are coercive, trap physicians in jobs, and force them to unfairly bear the economic harm of limited or no employment mobility. Most non-competes are unilaterally imposed, meaning the losses for an employee that result from having to comply with a non-compete, both in terms of income and patient relationships, are far greater than the threat of competition they might pose for their employers.

This imbalance can negatively affect workers’ earnings, job quality, and even patient care. The FTC found that non-competes limit patient access to care, including emergency care, and negatively affect the quality of care.

Non-competes can also lead to retaliation by the healthcare professionals bound by them who speak out against poor working conditions, corporate interference with clinical judgment, or dysfunctional practice operations.

Not surprisingly, hospital associations are advocates for non-competes, stating they actually improve patient care. They argue non-competes make in-practice referrals more likely, increase revenue and wages, and provide patients with more integrated care.

The Final Rule The Final Rule would effectively ban employers and other entities from taking any

action, legal or otherwise, to enforce existing non-compete clauses or require any worker or executive to enter a non-compete. The Rule defines the term “worker” to include employees and independent contractors. In addition, the employer could not “represent” to any person that a worker is subject to a non-compete clause.

The Final Rule would also require an employer to provide clear and conspicuous notice to workers subject to a prohibited non-compete that the clause will not be, and cannot be, enforced. This includes giving notice to former workers that are still under a non-compete. As with most regulatory schemes, the Final Rule contains exceptions, such as senior executives with existing non-competes, the bona fide sale of a business, and causes of action to enforce non-competes that arise.

The ultimate impact of the Final Rule on the availability and quality of patient care remains to be seen if and when it is enacted. Physicians would have the freedom to leave their current practice arrangements for more appealing opportunities without having to leave the communities in which they have established personal and patient relationships and goodwill. On the other hand, hospitals and practice groups could see increased physician turnover and higher overhead associated with hiring and retaining practitioners, including in underserved areas that need them. If quality patient care happens when both the treating physician and the entity they work for thrive, whether the FTC’s non-compete ban would support this crucial synergism is yet to be determined.

Zoe Jessie is a healthcare law attorney with Sturgill, Turner, Barker & Moloney, PLLC. She can be reached at zjessie@sturgillturner.com or 859.255.8581. This article is intended to be a summary of state or federal law and does not constitute legal advice.

ISSUE #153 7

Finance

Goals-Based vs. Cash Flow-Based Planning: Know Your Advisor’s Approach

BY D. SCOTT NEAL, CPA, CFP

Financial planning over the long term can be approached in different ways, depending on whether the focus is on achieving specific financial goals or maintaining sustainable cash flow over an extended period. Both goals-based and cash flow-based long-range financial planning are strategic methods that aim to ensure financial security and success over time, but they differ in their approach, underlying assumptions, and implementation. This article explores the differences and similarities between these two long-term planning approaches. You should know the pros and cons of each, and which is being used before engaging a financial advisor.

Goals-Based Long-Range Financial Planning 1. Definition and Focus: Goals-based longrange financial planning is centered around identifying and achieving specific financial objectives over a long period. These objectives can include retirement, purchasing a home, funding children’s education, or simply building wealth. The planning process involves determining the future financial needs associated with these goals and creating a roadmap to achieve them.

2. Time Horizon: The time horizon in goalsbased long-range planning is typically extended, often covering several decades.

This approach requires forecasting future expenses, savings needs, and investment returns to ensure that the defined goals are met within the set timeframe.

3. Personalization and Flexibility: This approach is highly personalized, as it is built around the unique goals and aspirations of the individual or organization.

However, while it allows for a tailored financial plan, it may be less flexible in adapting to changes in financial circumstances without a thorough reassessment of the goals and the plan itself.

4. Investment Strategy: Investment strategies in goals-based long-range planning are closely tied to the nature and timing of the goals. For example, long-term goals like retirement might involve more aggressive investment strategies focused on growth, while shorter-term goals might prioritize capital preservation and liquidity.

5. Psychological Impact: The psychological benefit of this approach is its motivational aspect—tying financial planning to specif-

ic, meaningful goals can provide a strong sense of purpose. However, there is also the potential for stress if the goals appear out of reach or if progress is slower than anticipated.

Cash Flow-Based LongRange Financial Planning 1. Definition and Focus: Running out of cash at some future date is rarely, if ever, anyone’s goal. Cash flow-based long-range financial planning focuses on maintaining sustainable cash flows over the long term, ensuring that income consistently exceeds or matches expenses throughout the planning period. The primary objective is to maintain financial stability while supporting long-term financial goals.

2. Time Horizon: Like goals-based planning, cash flow-based long-range planning spans several decades but with a focus on ensuring continuous cash flow to meet both current and future financial needs. This approach involves forecasting long-term income and expenses, including potential changes in income sources, inflation, and life events that may impact cash flow.

Empowering physicians to focus solely on the demands of their clinical practice.

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3. Flexibility and Responsiveness: One of the strengths of cash flow-based long-range planning is its flexibility. It is designed to adapt to changes in income, expenses, and financial priorities over time. This adaptability makes it particularly useful in managing long-term financial risks and uncertainties.

4. Investment Strategy: In cash flow-based long-range planning, the investment strategy is designed to support consistent cash flow. This often involves a mix of income-generating investments, such as bonds, dividend-paying stocks, or real estate, along with growth-oriented investments that can provide long-term capital appreciation to support future cash flows.

5. Psychological Impact: The psychological benefit of this approach lies in the reassurance of knowing that cash flow needs will be met over time. This stability can reduce financial anxiety, particularly in retirement or other life stages where income might be less predictable. However, the focus on maintaining cash flow in the short term might sometimes lead to a more conservative investment approach, potentially limiting growth opportunities.

Comparison and Contrast 1. Approach to Financial Goals: In goalsbased planning, the primary focus is on achieving specific long-term objectives, with cash flow management being secondary to the overall goal. In contrast, cash flow-based long-range planning views maintaining healthy cash flow as the primary objective, with long-term goals being integrated into the cash flow plan.

This difference in focus leads to varying

approaches in financial decision-making and prioritization.

2. Risk Management: Both approaches involve managing long-term financial risks, but they do so differently. Goalsbased planning often involves higher risk, as it requires making assumptions about future investment returns and expenses to meet long-term goals. Cash flow-based planning tends to be more conservative, focusing on ensuring that cash inflows are sufficient to meet outflows, thus managing risk by maintaining liquidity and financial stability.

3. Implementation and Monitoring: Goalsbased planning requires a comprehensive and often complex implementation process, including detailed projections, regular monitoring, and adjustments to ensure that goals remain on track. Cash flow-based planning, while also requiring regular monitoring, may be simpler in terms of implementation, as it focuses on the balance between income and expenses. However, both approaches require ongoing review and adjustments to respond to changing circumstances and ensure long-term success.

4. Applicability: The applicability of each approach depends on the individual’s or organization’s financial situation and priorities. Goals-based planning is ideal for those with specific long-term objectives, such as retirement or estate planning, where achieving a particular goal is the primary concern. Cash flow-based long-range planning is more suitable for those who prioritize maintaining financial stability and flexibility, especially in the face of potential income variability or unexpected expenses.

5. Integration: In practice, many individuals and organizations benefit from a combina-

tion of both approaches. A hybrid approach, like that used at our firm, involves using goals-based planning to define and work toward specific long-term objectives while employing cash flow-based strategies to ensure that short-term and long-term cash flow needs are met. This integration allows for a more balanced approach to financial planning, addressing both the achievement of goals and the maintenance of financial stability over time.

Conclusion Goals-based and cash flow-based longrange financial planning each offer distinct advantages and cater to different financial priorities. Goals-based planning provides a clear path toward achieving specific long-term objectives, but it requires careful management of risks and regular adjustments. Cash flow-based planning emphasizes maintaining financial stability over the long term, ensuring that income or assets consistently meets or exceeds expenses, thus supporting both current and future financial needs.

The choice between these approaches depends on individual or organizational circumstances, priorities, and risk tolerance. For many, a hybrid approach that combines the strengths of both methods may offer the most comprehensive and effective long-term financial strategy. By balancing goal achievement with cash flow management, individuals and organizations can navigate the complexities of long-range financial planning with greater confidence and security.

Scott Neal, CFP, CFP, is the president of D. Scott Neal, Inc. a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. He can be reached at scott@dsneal.com or by calling 1-800-344-9098.

ISSUE #153 9

Cover Story

Individualized Care.

Built to Last.

Kentucky Bone & Joint Surgeons excels as an independent orthopedics and sports medicine practice by attending to details and providing customized care

BY GIL DUNN LEXINGTON Is a four-doctor medical practice

that is physician owned and managed, with fellowship-trained orthopedic surgeons, sustainable? “Yes, absolutely, if they have a solid foundation of highly motivated physicians, PAs, and administrative staff and continue to provide optimal patient satisfaction and outcomes,” says Kaveh Sajadi, MD, managing partner for Kentucky Bone & Joint Surgeons.

“We provide exceptional, patient-focused, individualized, cutting edge orthopedic and sports medicine care. That’s why we’re successful, even in a challenging fiscal environment where insurance companies pay hospital-based healthcare systems more than they reimburse private practices for the same procedures.”

Founding Father and Son Kentucky Bone & Joint Surgeons was founded by Kooros Sajadi, MD, as a sole practitioner practice. His son Kaveh joined the practice after his fellowship training in 2006.

Kaveh took over as managing partner in 2012 when Kooros retired.

“Being the managing partner gives me the view behind the curtain in the business of healthcare, making me a better steward of cost-effective healthcare,” says Sajadi.

Kaveh Sajadi, MD, grew up in Lexington and received his undergraduate degree from Vanderbilt University and medical degree from the UK College of Medicine. He completed his orthopedic surgery residency at the prestigious Campbell Clinic-University of Tennessee, and then did a fellowship in shoulder and elbow surgery at the Hospital for Joint Diseases-NYU 10 MD-UPDATE

“Being the managing partner gives me the view behind the curtain in the business of healthcare, making me a better steward of cost-effective healthcare.” — Kaveh Sajadi, MD

Medical Center, where he met and trained under Dr. Joseph Zuckerman, MD, an internationally recognized expert in shoulder surgery.

“I’ve stayed in contact with Dr. Zuckerman throughout my career. We talk five or six times a year. He was a great teacher and continues to be an inspiration to me,” says Sajadi.

What’s New in Shoulder Replacement?

The shoulder is the body’s most complex joint, with the widest array of motion and use, says Sajadi. “I chose to specialize in shoulder because I like to work with my hands and my mind. I get the satisfaction of working with multiple generations of patients, from adolescents to mature seniors. It may be a cliché, but I like seeing my patients get better and fixing their problems.”

Shoulder replacement and repair continues to innovate. Sajadi employs both the reverse

shoulder and the subscapularis sparing techniques when appropriate. Computer assisted mapping gives Sajadi real-time input on where to make the cuts on the more challenging presentations of bone deformities.

“Computer-assisted surgery helps a surgeon stay in a very narrow range when making cuts on the humerus, lowering the chance for replacement failure and additional surgeries,” says Sajadi.

Biologics continue to offer new treatments, both platelet-rich plasma (PRP) and xenograft transfer of bovine tendon tissues, says Sajadi, who has designed a shoulder joint replacement product now in trials and seeking FDA approval, possibly ready for market in the fourth quarter of 2025. “We’ve been working on it for a long time,” he says.

In addition to meeting patients in clinic, with surgery two days a week, administrative duties as managing partner, consulting, and designing new shoulder parts, Sajadi also has a faculty appointment at UK where he teaches some of the finer points of shoulder surgery to fifth-year UK orthopedic residents and sports medicine fellows. “Even if they don’t become

Cover Story

Kentucky Bone & Joint Surgeons, all fellowship trained. Daniel Hackett, Jr., MD, Kaveh Sajadi, MD, managing partner, David A. Hamilton Jr., MD, Samuel Coy, MD

shoulder surgeons, I hope my teaching will make my students and fellows better orthopedic doctors,” he says.

On the horizon for Kentucky Bone & Joint is adding a hand specialist and hip-replacement surgeon. “We are actively recruiting for those positions and are talking with several fellows and residents now,” says Sajadi.

Meet Samuel Coy, MD Samuel Coy, MD’s, roots are deep in Central Kentucky medicine and agriculture. He says his father, James Coy, MD, practiced orthopedics so he could support his other passion, the family farm, which had been in the family for generations, first as a tobacco farm and more recently raising beef cattle.

Coy shadowed his father during his youth and embraced the dual roles of physician and farmer. Coy wore a leg brace as a child for a club foot, before becoming a high school and college athlete as a swimmer. Orthopedics has always been a part of his life.

Coy himself still works the farm whenever possible, so it’s no surprise that a memorable patient was a farrier, a blacksmith, who came to

see him recently for a knee fracture he sustained when he fell while working out.

“I am amazed by what some patients can do when they’re highly motivated,” says Coy. “My patient needed to get back to work as soon as possible even though his work involved being on his knees. We repaired the kneecap fracture and set up his post-op rehab plan with physical therapy, and within months he was jogging and working again with his horses.”

Coy grew up in Richmond, Kentucky, received his BA in religious studies from Centre College, and studied abroad in London, Israel, and Ecuador. He received his medical degree from Vanderbilt University’s School of Medicine, completed his orthopedic surgery residency at the University of Chicago, and took fellowship training at the Steadman Hawkins Clinic of the Carolinas before returning to Kentucky in 2009 to join Kentucky Bone & Joint Surgeons where he is a partner.

“My training and studies gave me opportunities to live in larger cities for a while, but I always knew that I would settle in Central Kentucky to raise a family while being close to my family and the farm. All that plus working PHOTOS BY PAUL MARTIN

“We pride ourselves on providing personalized, patient-focused, customized orthopedic care.” — Sam Coy, MD

in a private, physician- owned orthopedic and sports medicine practice is the best of both worlds,” he says.

The Knee Doctor Being the knee specialist at Kentucky Bone & Joint Surgeons gives Coy a wide patient population, from young athletes with sports injuISSUE #153 11

Cover Story

“Being an orthopedic surgeon and sports medicine doctor is a perfect fit for me.” — Daniel Hackett, Jr., MD ries and adult worker’s comp cases, to mature individuals who need nonoperative therapy or joint replacement.

“The initial patient interview is so important and vital in deciding how to proceed,” says Coy. “We pride ourselves on providing personalized, patient-focused, customized orthopedic care. Dr. Sajadi makes that the goal of Kentucky Bone & Joint. We’re not the biggest practice with the highest patient volume, so we can take our time with each patient,” he states.

Multiple trends are emerging in orthopedics and sports medicine, says Coy. Three that he sees most frequently are the growth of outpatient joint replacement surgery; computer-assisted navigation in knee surgery; and nonoperative remedies for joint repair such as PRP. “The need for joint repair and replacement among baby boomers is growing exponentially.

I don’t see it stopping,” says Coy. “People want to stay active. With new weight loss medications and innovations in arthroscopic surgery, there will never be a shortage of patients.”

Meet Daniel Hackett, Jr., MD Complex shoulder replacement and repair are Daniel Hackett, MD’s, forte, an interest that he believes stems from working with his grandfather in his wood shop while growing up in Alabama. “I liked working with my hands and learned wood crafting from my grandfather. I played sports in high school and college.

Biology and the human body and the skeletal system made sense to me. I knew in high school that I wanted to be a doctor and was drawn to orthopedics in medical school. Being an orthopedic surgeon and sports medicine doctor is a perfect fit for me,” says Hackett.

Shoulder replacement, including both anatomic and the reverse shoulder procedure and rotator cuff repair “are the bread and butter” of his practice, says Hackett. He also performs scapular reattachment and winging surgery, plus tendon transfers and sternoclavicular abnormalities.

He recalls a patient who, after a motorcycle injury and nonoperative repair for his shoulder, developed a scapular malformation and almost 12 MD-UPDATE

complete loss of use. Hackett used 3D printing to create a new shoulder joint, which restored the patient’s shoulder’s structure and function. “We recreated the shoulder joint he was missing and returned him to a normal life,” says Hackett.

Hackett’s patient population falls into two categories, common for orthopedic surgeons: the sports injury in adolescents to those in their mid-thirties, and the chronic arthritic pain patients who are sixty plus years old. “Bad luck or a lot of birthdays bring me my patients,” he says.

Losing Sleep and Function over Shoulder Pathology If there is a gender bias in shoulder repair and replacement, it seems to point toward young males and older women, says Hackett.

“I see sports and work or trauma injuries among young men, then chronic pain and joint degradation among senior women,” he says. Among the geriatric population, loss of function and sleep are usually the final motivation.

“My older female patients tell me that not being able to do simple things like reaching for a coffee mug on the cupboard’s second shelf because they can’t lift their arm really affects their quality of life,” says Hackett.

Not being able to sleep at night because of shoulder pain also brings patients to Hackett who says the debilitating effects of impaired shoulder pathology has effects beyond what one might think. “Not being able to sleep because my patients have shoulder pain causes them both mental health distress and potentially cardiovascular problems,” he says.

Innovation in Shoulder Replacement and Repair Preoperative computer mapping is one of the innovations in shoulder replacement and repair and “gives me a leg up in surgery,” says PHOTO BY PAUL MARTIN AND PROVIDED BY DANIEL HACKETT, MD

Dr. Daniel Hackett played NCAA D-1 football at Washington & Lee University.

Hackett. Knee replacement surgeons have been using computer mapping for some time, but it is now coming into use in shoulder surgery.

Hackett points to some additional innovations in shoulder replacement as game-changers and potential game-changers. The reverse shoulder technique, “putting the ball of the joint in the socket rather than at the head of the humerus, was huge for shoulder replacement,” says Hackett. He uses the reverse shoulder technique when the head of the humerus has abnormal wear due to stress on the joint when the rotator cuff has failed. He is likewise enthused by the subscapularis sparing approach in shoulder replacement, which he uses to avoid taking down the rotator cuff tendons during shoulder joint replacement surgery. This dramatically enhances recovery and limits restrictions after shoulder surgery, allowing patients to remove their sling the day after surgery and get back to their normal life in a much more rapid manner.

Hackett continues, “We’re scratching the surface of what biologics and platelet-rich plasma will add to nonsurgical orthopedics.

Our practice is driven by research and evidence-based results, so we use it in applications that have data supporting its use.”

Hackett joined Kentucky Bone & Joint Surgeons in 2017 and is a partner in the practice.

Cover Story

“I wanted to learn a new skill set that was not being widely covered in our area.” — David A Hamilton, Jr., MD difficult path for the doctor is usually best for the patient. I’ve found that to be more and more true the longer I’ve practiced.”

Hamilton joined Kentucky Bone & Joint in 2021. His patient volume is expanding as is his coverage area, which encompasses Lexington and the surrounding cities of Paris and Winchester. His patient cohort is adolescent to adult with the common variety David A. Hamilton Jr., MD, is the foot and ankle specialist of sport related injuries, fractures, at Kentucky Bone & Joint flatfoot deformity, plantar fasciitis, Surgeons. Prior to medical and Charcot foot deformity. He school, he was a walk-on has a particular interest in bunquarterback for the UK ion deformity, most commonly football team. in women, for which he performs three dimensional and minimally Meet David Hamilton, MD invasive bunion correction.

Foot and ankle are not the most-widely Limb salvage and diabetic foot disease are chosen specialty areas by orthopedic surgeons, a growing component of Hamilton’s practice. but David A. Hamilton, Jr., MD, says, “I Employing new technologies, Hamilton says he wanted to learn a new skill set that was not uses amniotic allografts from umbilical cord tisbeing widely covered in our area. My wife and sue to facilitate wound care. “Diabetes is a major I wanted to live in Lexington. It was a win-win health concern in Central Kentucky, leading situation for us.” to many complications including amputation.

Hamilton grew up in Lexington, attended Patient mortality increases dramatically when Tates Creek High School, and received his diabetic wounds and infections lead to ampuundergraduate degree at UK where he was a tation. Out of necessity, I’ve tried to develop walk-on quarterback for the UK football team. a more comprehensive skill set to help prevent He completed an MBA at the UK Gatton those negative outcomes,” says Hamilton.

College of Business Administration before Hamilton is bringing a charitable program medical school at the UK College of Medicine. that he participated in while in Pittsburgh to He completed a residency in orthopedics at Kentucky. His fellowship mentor in Pittsburgh, UK followed by a fellowship in foot and ankle orthopedic surgeon Stephen Conti, MD, along at the University of Pittsburg Medical Center. with his son Matt, formed “Our Hearts to Hamilton credits several mentors at Your Soles” in 2004. The purpose of the orgaUK orthopedics for guiding and inspir- nization, which has been spreading across the ing him, including Ray Wright, MD, Eric country, is to provide those less fortunate with Moghadamian, MD, Darren Johnson, MD, shoes and free foot examinations.

Carter Cassidy, MD, and Jeff Selby, MD, “Dr. Conti has collaborated with different outgoing chair of the orthopedic department. shoe retailers to offer homeless people in “Nobody’s clinical practice is perfect, but Dr. Pittsburgh boots and shoes prior to the winter Selby’s approach is the probably the closest months,” says Hamilton. “Traditionally his I’ve seen,” says Hamilton. “He’s a great doctor fellows have taken that program to their home and teacher. He taught us that when there is communities, and that’s something I’m going an easy or difficult way to do things, the more to do in Kentucky.”

PHOTO BY PAUL MARTIN AND PROVIDED BY DAVID HAMILTON, MD

Hamilton recently reached an agreement with Red Wing Shoes, which will donate shoes and boots to the Kentucky chapter of Our Hearts to Your Soles. Donations will start this holiday season. More information will be available on the Our Hearts to Your Soles website: www.heartstosoles.com.

In his spare time, Hamilton coaches his daughter’s flag football team and the chess club at Christ the King School in Lexington.

Fellowship Training Kentucky Bone & Joint Surgeons will soon be the host site of a foot and ankle fellowship program, says Hamilton. He applied for the program through the American Orthopedic Foot and Ankle Association (AOFAF), and his application was accepted. He projects that fellowship training will begin in 2026.

“After five years of working in this specialty, I feel that I have something to offer to orthopedic residents who want to pursue the subspecialty of foot and ankle. We’ll be interviewing fellowship candidates this fall,” says Hamilton.

Managing partner Sajadi says that having a fellowship program at Kentucky Bone & Joint Surgeons will enhance the practice’s regional and national stature and coalesces well with the practice’s goal of teaching and training the next generation of orthopedic surgeons.

In Conclusion The four fellowship-trained orthopedic surgeons at Kentucky Bone & Joint Surgeons are a unique mix of doctors. All of them played sports in high school or college and were drawn to the specialty because of a common passion to help their patients return to normal everyday activity, either through surgery or nonsurgical therapies.

All four expressed their shared joy in working with their hands and fixing patients’ problems, restoring function, and relieving pain and discomfort. Being part of a physician-owned private practice gives them input into how the practice is run, flexibility, and work/life balance, even with the additional responsibilities that come with the territory.

Is it sustainable? Absolutely, says Sajadi.

ISSUE #153 13

The Joint Is Jumping

Sky-diving orthopedic surgeon Miguel Daccarett, MD, is hip to the latest advancements in joint preservation and replacement

BY JIM KELSEY

LOUISVILLE They say the definition of insanity

is doing the same thing over and over and expecting different results. Well, call Miguel S. Daccarett, MD, FAAOS, insane then because he has safely made more than 3,100 jumps as a professional skydiver, yet he expects the result to be different someday. If and when he sustains an injury, he just hopes that he receives the same professional, attentive care that he attempts to provide his patients as an orthopedic surgeon at the UofL Health.

“As a skydiver, I know I’m going to be on that operating table someday,” says Daccarett, who serves as the associate trauma fellowship program director and as an associate professor in the Department of Orthopedic Surgery at UofL. “Just a little mistake and I will be on that table, so I want my patients to be treated exactly the same as I would like to be treated. I try to communicate this to the people I train.”

That same lesson was likely instilled in him by his father, who was a pediatric surgeon in Colombia and inspired Daccarett to become a doctor as well. He attended medical school at Pontificia Universidad Javeriana in Bogotá.

His went on to attend El Bosque University to become an orthopedic surgeon. He completed a trauma fellowship at the University of Louisville, an oncology fellowship at the University of Florida, and a sports medicine fellowship at Harvard Children’s Hospital.

Today, he is a board-certified orthopedic surgeon, specializing in orthopedic trauma 14 MD-UPDATE

Miguel Daccarett, MD, FAAOS, serves as the associate trauma fellowship program director and as an associate professor in the Department of Orthopedic Surgery at UofL.

and sports medicine. Among the conditions he treats are fractures of the pelvis, acetabulum, hip, knee, ankle, and upper and lower extremities, with particular interest and training in hip preservation surgery to avoid early hip replacement.

“I was living in Columbia at probSkydiving in a “big-way” sequential formation with 36 ably in the worst time of Columbia’s people. Dr. Daccarett is in the black suit on the top line of history,” says Daccarett, explaining the picture, second from right to left. how he became interested in orthopedics. “Initially, I wanted to be a minutes to an hour to a more dynamic way cardio thoracic surgeon, but when the war in to exchange ideas,” says Daccarett. “When I Columbia started, the musculoskeletal trau- started teaching nationally 20 years ago, all mas — the fractures, all the bone injuries — I the teachings were formal lectures. Now, most was surrounded by those types of patients. of the courses we do are based on cases of Orthopedics slowly became my cause in life.” trauma — a broken femur, for example. The After working at the University of Chicago, trainees ask and answer questions themselves, Daccarett learned of an opportunity to return and we guide those answers to have a better to the University of Louisville in 2023. Having application of the knowledge into our real fond memories of Louisville and knowing all cases. It’s more dynamic and more applicable the surgeons he would be working with, he to the needs of the patients.” eagerly accepted.

Daccarett, whose oldest patient to date was a His work is a combination of clinics and 103-year-old with a hip fracture, treats a patient surgeries, with the organization of courses population that includes all ages and genders. mixed in. He estimates that he spends one- Such a broad spectrum requires taking the time and-a-half days a week in the clinic and three to understand the varied needs of each patient. days a week in surgery, which also sometimes “When you treat a patient in trauma, doubles as a teaching opportunity. the goals can be completely different,” says “Teaching has migrated from lectures of 45 Daccarett. “For an athlete 20 years old, the

PHOTOS BY JOHN LAIR AND PROVIDED BY MIGUEL DACCARETT, MD

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Teaching in Dar es Salaam, Tanzania, with the AO Alliance. The AO Alliance is a nonprofit development organization dedicated to strengthening care of the injured in over 30 low- and middle-income countries (LMICs) in Sub-Saharan Africa and in Asia.

goal might be to come back to play football again. For a 50-year-old, it might be able to walk without pain, and for an older patient it might be to take care of themselves.

“When we meet with patients, we set the goals,” Daccarett continues. “I want to know when and how the problem started. Is there a history of trauma? What makes it better?

What makes it worse? Once we define what the problem is, I want to know what the patient’s goals are to be able to decide on a specific treatment for that patient.”

Hip Replacement or Preservation While his overall patient population spans all ages, Daccarett’s hip preservation patients fit into a much smaller age range. These patients range in age from about 12 to 40 years old; he describes the ideal patient for this procedure as a 20-year-old presenting with dysplasia of the hip due to the socket being underdeveloped. The resulting treatment corrects the hip and creates a more normal weight-bearing hip. On the other hand,

a patient presenting with severe arthritis, for example, is not a good candidate for hip perseveration and would likely benefit more from a total hip replacement.

“Hip preservation is not something that everybody does,” says Daccarett. “It requires specific training and experience. It is not as common as replacing a hip or knee. Not too many people know that we can save those joints, especially in late adolescence or early adult life. It is a misconception that once you have damage to the cartilage of the hip, you have to replace it. In many cases, we can just replace the portion that is damaged and preserve the hip.”

Daccarett says that recent progress in hip procedures now allows specialists like himself to potentially manipulate and realign the acetabulum to a better position. In other instances, vascular necrosis can often be corrected via surgical dislocation of the hip and replacement of the bone and cartilage with a new bone from a donor.

“The femoral head has a good amount of diseases or malformations that can happen, including a slipped cap, in which we can go inside the hip and do surgical dislocation of the hip,” says Daccarett. “Through surgical dislocation of the hip, we can work the femoral head and make it more normal so the patient can bear weight on that hip.”

Despite the advancements in hip preservations, there are still times when a total hip replacement is the best course of action.

Daccarett gives the example of a patient who is overweight, has diabetes, and is a smoker. For such a patient, the risks of performing hip pres-

Orthopedics:Hip Replacement

ervation are heightened, and a hip replacement is often the preferred course of action.

“Fortunately, the evolution of the total hip replacement allows you to have a new hip and be able to be active, including running, biking, or swimming,” says Daccarett. “The patient can have an active, healthy sporting life.”

Rehabilitation Is Key Regardless of whether the procedure is hip preservation or hip replacement, Daccarett points out that rehabilitation is key to eventual success.

“More important than the operation itself is rehabbing the patient,” he says. “We work together with rehabilitation doctors to protect the operation we did and, at the same time, not let the patient get too stiff. They will create a rehabilitation program in which the range of motion can be performed without all of the weight on the lower extremities.”

Daccarett has a clear passion and dedication to helping his patients in whatever manner best fits their needs and goals. He follows through on that commitment by staying informed on the latest techniques and advancements.

“My philosophy of care is patients come first,” says Daccarett. “I treat patients as if they are members of my own family — with compassion, professionalism, and common sense. I have a commitment to my patients and their families to deliver care that is supported by evidence-based medicine and performed in a multidisciplinary fashion.”

It is a commitment he hopes he instills in other orthopedic surgeons… whether or not he actually ever needs their care himself.

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ISSUE #153 15

Orthopedic Servi

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Orthopedics:Sports Medicine:Shoulder Surgery

Sparing the Rotator Cuff New surgical technique quickens recovery time, yields high patient satisfaction

BY GIL DUNN LONDON Trusting his instincts has served

Kevin Magone, MD, well in his professional career, from choosing his specialty of orthopedic surgery and sports medicine to his decision to join CHI Saint Joseph Health in London in southeastern Kentucky.

“When we interviewed here four years ago, we had a good feeling from the hospital staff, but we had no idea how much we would enjoy this community. The people here are really nice, not just the hospital staff, but the community as well. Also, I didn’t realize how quickly I would become so busy in my medical practice and covering the local team sports,” says Magone.

A new aspect of his orthopedic and sports medicine practice that Magone instinctively felt would be successful is using the subscapularis sparing surgical technique in his shoulder replacement cases. He states, “I had been trained in the subscapularis sparing technique in my orthopedic fellowship, so I was familiar with it. About eight months ago I decided to start using it with my shoulder replacement patients to achieve better outcomes, quicker recovery time, and more patient satisfaction.

So far, my patients are very happy with the results, and I am too.”

Magone explains that there are two types of shoulder replacement surgical procedures: One is the reverse shoulder approach (RTSA) when the normal ball ball-and-socket relationship is reversed and the ball is placed in the socket, not at the top of the humeral bone. The other option is the anatomic shoulder replacement, known as total shoulder arthroplasty (TSA). In the traditional anatomic technique, the rotator cuff is taken down, he says, to insert the new shoulder joint. Taking down the rotator cuff musculature requires the patient to wear a sling for six to eight weeks to support the arm while the rotator cuff heals.

18 MD-UPDATE

Kevin Magone, MD, orthopedic surgeon, CHI Saint Joseph Health in London, Kentucky.

“Patients don’t like having to keep their arm in a sling for six weeks after surgery,” says Magone.

In the subscapularis sparing technique, Magone says he doesn’t take down the rotator cuff while inserting the new shoulder joint.

The caveat to not taking down the rotator cuff during this procedure is that there are not any prior tears in the rotator cuff. “I tell my patients before surgery that I won’t know for certain if the rotator cuff is intact until I see it. We have looked at it in advance by MRI, but until I can see it with my own eyes, I can’t be certain. So far, I haven’t had to change course after about 18 surgeries in eight months, but there’s always that possibility. My patients understand that and are happy with the process,” says Magone.

Benefits of Sparing the Subscapularis Patients derive multiple benefits from the subscapularis sparing technique. The most obvious is shorter recovery time when the arm can be released from a sling in about one week rather than eight weeks, after the swelling subsides and the small incision wound heals.

PHOTO PROVIDED BY CHI SAINT JOSEPH HEALTH

Pain management associated with post-operation recovery is about the same, or less, says Magone. He theorizes that patients do better with the pain when they are not using the sling and have better range of motion and normalized activity. “It’s subjective, and long-term data is still being collected, but my short-term results tell me that patients are much happier being out of the sling quicker because of not taking down the rotator cuff,” he says.

“I really want patients who need shoulder replacement surgery to know that this procedure, and the subscapularis sparing approach, is now available to them in London, Kentucky.

They don’t have to drive to Lexington or Knoxville to have it done. I’m seeing patients with outcomes in six weeks that otherwise would take six to eight months,” says Magone.

A Doctor’s Role in the Community Not only is Magone bringing new surgical techniques to London, he and his family are quickly putting down roots and becoming totally immersed in the southeastern Kentucky community. Magone, a multi-sport high school athlete, is now the team doctor for Whitley County and both North and South Laurel County high schools and middle schools. He says he covers all the sports including football, basketball, soccer, baseball, and even golf. He says his goal is to support the school athletic trainers and be a resource when needed. “The athletic trainers do a great job here; they are very well trained in their specialty,” he says.

Magone and wife Ashley now have three children of their own, and all of them are involved in some type of sports activity. “My older two boys Mason and Maverick are nine and seven. They play football, basketball, baseball, and golf and are on a swim team.

My youngest, our daughter Mila, takes dance, does gymnastics, and starts softball soon. We stay very busy,” he says.

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Orthopedics:Sports Medicine:Shoulder Surgery

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Kevin Magone, MD, quarterback #8, is now team doctor for high school sport teams in London, Kentucky.

Magone’s decision to become an orthopedic surgeon was a natural for him because his father, Jerry, is a retired orthopedic surgeon who practiced at Middletown Regional Hospital, just north of Cincinnati. Magone was further drawn to the profession because he likes to work with his hands and he had some experience in orthopedics as a high school athlete. He suffered an ACL injury and broke his hand in football, which required surgery, and in basketball he re-tore his ACL.

Magone received his undergraduate degree from the Ohio State University and his medical degree from the Wright State University Boonshoft School of Medicine. He did his residency at Michigan State University McLaren-Flint Regional Medical Center before taking a fellowship in shoulder and elbow surgery at the NYU Langone Orthopedic Hospital in New York.

six months after surgery or treatment, they just want to tell me about all the things they can do now that they couldn’t do before.

That’s the best thing to hear; it really makes me happy and want to continue each day,” says Magone.

That’s a good feeling to have.

The Non-Surgery Surgeon

Orthopedics & Sports Medicine

It is a common misconception among patients, but not all shoulder or elbow problems need surgery, says Magone.

“Just because I’m an orthopedic surgeon, that doesn’t mean I have to operate on every patient. We always use a conservative approach first. Most of my patients are here for chronic, arthritic pain relief and restored function and increased range of motion.”

The follow-up patient visits motivate Magone. “When a patient comes in three to PHOTO PROVIDED BY DR. KEVIN MAGONE

KEVIN MAGONE, MD 160 London Mountain View Drive London, KY 40741 FOR PATIENT REFERRALS OR MORE INFORMATION CALL

606.864.0770 ISSUE #153 19

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Orthopedics:Sports Medicine

Dr. Luke Beggs, Tiff Haub, and Dr. McKinney, at the new Churchill Downs paddock.

Riders Up!

Norton Sports Health provides healthcare to athletes in one of the most dangerous sports

BY LIZ CAREY LOUISVILLE For Tiff Haub, MS, ATC, LAT,

and Nate McKinney, DO, providing care means going to the track and taking care of professional athletes in the one of the country’s more dangerous sports.

Haub, director at Norton Sports Health, and McKinney, medical director for Churchill Downs, provide medical care for jockeys and exercise riders at Churchill Downs, as well as for patrons who may have medical issues at the race track. The program helps jockeys who might not otherwise seek medical attention get the treatment that they need, as well as help them after some on-track injuries.

According to the Centers for Disease Control and Prevention (CDC), being a jockey is one of the most dangerous jobs in the country. In a report on jockeys, the CDC says that 100 jockeys have been killed on the job since 1950, 20 MD-UPDATE

and a study of injuries of licensed jockeys in the US found that more than 600 injuries are reported per every 1,000 jockey years. More than a third of those injuries occurred at and around the starting gate, another 16 percent occur during the home stretch, and 14 percent occur during the turns.

Haub says the Norton Sports Health program at Churchill Downs started in response to legislation passed to protect jockeys. The Horseracing Integrity and Safety Authority Act (HISA), passed in 2020, requires that jockeys, as professional athletes, get a sports physical and a baseline concussion test every year. In advance of the legislation going into effect in 2022, Haub says, Churchill Downs reached out to North Sports Health.

“Because we provide care to so many athletes around the area, they felt like our program and our sports medicine providers were great options to help them in accomplishing PHOTOS PROVIDED BY NORTON HEALTHCARE

these goals and stay compliant with this new legislation,” says Haub.

HISA mandates accredited tracks have a medical director; additionally, Kentucky state law mandates that a physician and a nurse must be present at race tracks on live race days.

Norton Sports Health has medical directors or supporting sports medicine physicians at the track on all 75 race days at Churchill Downs for both spring and fall meets. Additionally, the sports medicine department provides the sports physicals and baseline concussion test for the jockeys, says Haub. Since the program started, they have been able to add healthcare for race fans on live race days as well.

The Road to Churchill Downs For Haub, the jockey healthcare program offers her the opportunity to combine her love for horseback riding with her love of sports medicine. Haub received her bachelor’s

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degree in athletic training from the University of Toledo, and her post-professional master’s degree in athletic training. After working as a graduate assistant with the University of Kentucky softball program, Haub moved to the University of Louisville’s softball program and is currently pursuing a master’s degree in healthcare administration. Haub has also been an equestrian rider for some time.

At Churchill Downs, Haub and McKinney provide care to the track’s staff members.

When there’s an injury, there is medical help for the riders.

“Most of the time, the rider’s injuries are very traumatic,” says Haub. “Typically, the horses are going around 40 miles per hour, so when the injury occurs, it’s almost like being in a car accident with minimal protective safety equipment.”

While riders have equipment like helmets and vest to protect them and ensure their safety, accidents still happen. When accidents occur, the majority of injuries tend to be concussions, fractures, and sprains and strains.

But because the riders are only getting paid per race, sometimes getting their injuries treated is not their priority.

“Jockeys are professional athletes, but they’re not on a team. They’re self-contracted and they’re only being compensated when they’re riding and winning,” says Haub. “Our jockeys are very transient in nature, and they’re going to ride where they’re able to pick up rides. They are more driven to return to ride, and they’re going to ride with injuries that maybe other types of athletes wouldn’t.”

More than Treating Falls Norton Sports Health helps educate the jockeys and riders on other medical issues outside of injuries as well, Haub says.

“We’re also offering a seasonal education,” says Haub. “We’ve had our social worker on our sports health team come and talk to jockeys about mental performance and mental health and how that can affect their riding or their performance. We’ve had a performance dietician come and talk about nutrition because it is a weight class sport and how to stay healthy and maintain or cut weight. And we’re potentially having a weight

Orthopedics:Sports Medicine

management physician or primary care physician come in and talk about different substances that may be used to control weight and their effects on endurance athletes. So I think we’re just elevating what’s being offered.”

Trust before Treatment McKinney says the jockeys he evaluates during the yearly physicals tend to have some sort of past injuries.

“I can tell you from doing a lot of the physicals that I think most of them have had a clavicle fracture at some point in their career,” he says. “Head Tiff Haub performs a baseline concussion test. injuries unfortunately are “My whole goal is to keep them raccommon, ranging from concussion all the way ing, doing the sport that they love,” says up to skull fractures and serious brain bleeds. McKinney. “We just want to make sure that Interestingly, I see more abdominal injuries in they do it in the safest way possible.” this field than compared to other sports that we think of like football and basketball.”

The Toughest Group of Athletes McKinney, a nonsurgical orthopedist, did his When a jockey is injured on the race track, undergraduate work at Bellarmine University, they are immediately evaluated by EMTs, says and received his DO from Lincoln Memorial McKinney. If the EMTs determine that the University. Now in sports medicine at Norton injuries are severe enough, they send the jockOrthopedic Institute, he says the new program, ey to the hospital. If the injuries don’t warrant and the new legislation, helps the horse racing a hospital visit, they get moved to the back industry better monitor injuries and jockey of the track where the sports medicine prohealth. But, he says, gaining the trust of jockeys fessionals can evaluate them and determine is a crucial part of the program. how to treat them. The injuries he sees vary “When we first met the jockeys, they had wildly, he says. reservations about us because, in their eyes, “I remember one of my first few races, I we existed solely to remove them from the was there and a jockey fell off his horse early sport that they get their livelihood from,” says in the race,” he recalls. “He fell and was rolling McKinney. “If a jockey is hurt and can’t ride, around a lot, and it looked like another horse he doesn’t get a paycheck. Now that I’ve been had stepped on him. I’m seeing this happen, working there a couple of years, they’re famil- expecting the absolute worst and the guy pops iar with my face and they’re familiar with me. up, brushes off his chest and starts walking There’s less hesitancy on their end to open up back over. I think that was the first time I realto me and tell me about the things that they ized he’s got the ability sometimes to land like may be dealing with.” a cat. They are the toughest group of athletes, The goal remains to help the jockeys race hands down, that I’ve ever worked with.” safely, he says.

Other times, however, the news isn’t as good.

ISSUE #153 21

SPECIAL SECTION

Orthopedics:Sports Medicine

“Another example, was actually a jockey that I’m close with who had a scapula fracture, a shoulder blade fracture, and wanted desperately to ride in her remaining scheduled race for that day, but she couldn’t raise her arm above shoulder height,” he says. “I was really concerned about her having that fracture, and she’s the first jockey that I told that she couldn’t race. It was a hard thing for me to do.

It ended up being the right policy — she did have a fracture.”

McKinney ran track at Bellarmine, so helping jockeys return to the work that they love is a constant motivation for him. “As an athlete, I know I’d lose the sense of my independence, my freedom, if I wasn’t able to perform, if pain was limiting me from doing the things that I really enjoyed,” he says. “I think that’s my motivator, to help people keep doing the things that they love to do.”

Haub says the program provides her with the opportunity to combine her sports experience with her profession.

The Norton Sports Health team with the Kentucky Derby trophy.

“I have a unique background as an equestrian rider,” she says. “As someone who has sports medicine and healthcare administrative skills, I’m able to combine all three and be able to contribute. I know that this is an untapped area. I know that there’s work to be done and

that I’m able to support that initiative. I’m also passionate about the horse racing community in this area. These individuals deserve a medical provider and a medical institution that’s going to help provide access and elevate the care that they’re receiving.”

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SPECIAL SECTION

Orthopedics:Sports Medicine at ARH

Fixated on the Fix

ARH orthopedic surgeon Philip Collis, MD, relies on more than surgery to help his patients.

Dr. Philip Collis performs an anterior total hip arthroplasty at Hazard ARH.

BY JIM KELSEY HAZARD Philip Collis, MD, is an orthope-

dic surgeon specializing in sports medicine at Appalachian Regional Healthcare (ARH).

The duties of a surgeon are only some of the ways Collis spends his day treating his patients. With constant innovation and advancements in orthopedics and a commitment to a continuum of care at ARH, he can provide options for his patients beyond the operating table.

“Because of our title—orthopedic surgeon—the biggest misconception is that everything needs to be treated with surgery,” says Collis. “Maybe 80 to 90 percent of what we treat as orthopedic surgeons is non-operative. It’s more about managing patients, trying to avoid surgery, and trying to optimize their outcomes without having to undergo surgery.”

24 MD-UPDATE

Dr. Philip Collis joined Appalachian Regional Healthcare in 2022.

Like many orthopedic surgeons, Collis was drawn to the specialty partly because of his athletic background. Growing up in PHOTOS PROVIDED BY ARH AND PHILIP COLLIS, MD

Columbus, Ohio, he played soccer and basketball in high school and suffered what he terms “the typical run-of-the-mill sports injuries,” which introduced him to the world of sports medicine.

Collis was a pre-med major at Vanderbilt University, then attended the University of Louisville School of Medicine. He did a surgical internship at Orlando Regional Medical Center, followed by an orthopedic surgery residency back at the University of Louisville. He later completed a fellowship in sports medicine at the University of Miami (Florida).

Collis joined ARH in 2022.

Like many orthopedic surgeons, his positions have included working with local athletic programs. Collis was Western Kentucky University’s basketball physician for four years, and during his time in Florida, he worked with the University of Miami’s football and basketball teams as well as Major League

SPECIAL SECTION

Baseball’s Miami Marlins. In his current role at ARH, he serves as the local sports surgeon for the athletic teams in and around Hazard.

“The biggest difference between covering the college athletic programs and high school athletics is the amounts of resources that you have,” says Collis. “In college athletic departments, they have full-time athletic trainers for every sport and they have all sorts of resources when it comes to rehabbing, diagnosing, and assisting with the care of the athletes. When it comes to the high school level, we don’t have athletic trainers for all of the school’s sports here, so we rely more heavily on physical therapists. It’s up to the patient, the therapist, and myself to coordinate the patient’s rehabilitation program.”

The Patient Interview Is Key In the sports medicine side of his practice, Collis treats a variety of injuries, primarily to the shoulder or knee. For the shoulder, he performs arthroscopic surgeries, including rotator cuff and labrum repair. For the knee, he performs arthroscopic surgeries, including meniscus repair, ACL reconstruction, and other ligament reconstruction of the knee.

Collis estimates that close to 75 percent of his practice is either sports-related or acute injury. The other 25 percent is composed primarily of chronic conditions, where he frequently treats patients with arthritis, chronic pain, or in need of a hip replacement. His patients range in age from adolescents to those 80 years old and up.

Regardless of the patient’s age or presentation, Collis places a high priority on the first meeting with the patient.

“It’s all about getting a good history, getting to know the patient, what their lifestyle is, and what their lifestyle was before they had an injury or debilitating pain,” says Collis. “Then I try to get a feel for what their goals are for their outcomes. What are they trying to get?

Are they looking for something to deal with the pain, to deal with the function, or a com-

Orthopedics:Sports Medicine at ARH

bination of the two? Once we know that, we tailor our outlook and treatment plan based on their individual circumstances. Every patient has different wants and needs when they come in. We tailor our care based on what they are looking for and what their longterm goals are.”

The Nonsurgical Surgeon For many patients, their goal is to avoid surgery.

Collis, likewise, values the nonsurgical options.

“We try to lay out the easiest steps and treatments first and work our way up to whether or not they are Dr. Collis was Western Kentucky University’s basketball physician for four a candidate for surgery,” years before joining ARH. says Collis.

The good news, Collis says, is that if surgery ing an elderly patient regain their mobility is required, minimally invasive techniques and and independence via a hip replacement or other advancements ease the recovery process. a young athlete returning to the playing field “Orthopedic surgery is still relatively new, after an arthroscopic knee surgery. but we have made a lot of advancements in “It’s a problem-solving thing when it comes a short period of time,” says Collis. “Even in to orthopedics,” he says. “A lot of times, we the last 30 years, there has been such a rapid are presented with a problem that we can change in the way we treat things. Now, we actually fix or address. There is satisfaction in have arthroscopic surgery and technologi- helping a patient who comes in with an injury cal advancements in robotics. We are really that’s really limiting their lifestyle and their focusing on minimally invasive procedures happiness. It takes a toll on them in a lot of with more consistent and more predictable aspects—emotionally, financially, and physoutcomes.” ically. Being able to help them get through Collis says that, in addition to his sports that and get back to their normal self and background, he was drawn to orthopedic their normal lifestyle is the biggest thing that surgery because it offered the opportunity to I get out of it.” fix things rather than managing long-term It doesn’t sound very medical or technical, treatment programs for prolonged illnesses. but “Doctor of Helping People Feel Better” While he admires and respects the work of might be the most appropriate title for orthothe medical professionals who perform that pedic surgeons like Collis. Committed to work, he finds it rewarding to be able to fix “fixing the problem,” using all the resources whatever is broken. That might mean help- available.

“It’s a problem-solving thing when it comes to orthopedics. A lot of times, we are presented with a problem we can actually fix or address.”

— Dr. Philip Collis, orthopedic surgeon, Appalachian Regional Healthcare ISSUE #153 25

SPECIAL SECTION

Orthopedics:Nonsurgical Orthopedics

Sports Medicine Enters a New Era Nonsurgical orthopedic treatments allow Baptist Health osteopathic doctors to explore patient needs

BY LIZ CAREY

Athlete First, Then Healer

LOUISVILLE/NEW ALBANY Sometimes, the best

Sports medicine was always in her mind, she says.

“My whole life I was excited to put Band-Aids on, and take splinters out and those type of things. As I got older, I became more amazed by the human body and what it’s capable of and how everything is so interrelated, how the body is able to Some of Dr. Naylor’s patients are women who adapt and heal,” want to play with their grandchildren. she says. “From there I knew that with primary care, I would patients, both be able to build relationships and have con- in the office tinuity of care and be able to take care of or on the Kathleen Naylor, DO, sports my patients and athletes on a whole level as sidelines.” medicine specialist with Baptist opposed to more specialized care.”

T h o s e Health Sports Medicine.

Naylor’s shift to primary care and nonsur- nonsurgical gical options for orthopedic issues came out treatments are relevant to more than just athof her desire to treat the whole patient. Her letes, says Naylor. training as a DO helps her see how the body “I think when people have a musculoskelas a unit functions, and that structure dictates etal issue, they just assume that orthopedics function, especially from the musculoskeletal is where they need to go,” she says. “But for standpoint. Naylor says she came to realize a lot of people, if it’s just a sprain or a strain, that continuity of care with her patients and that’s something that sports medicine specialbeing able to manage even primary care issues izes in. If it is something that we feel needs helped her find nonsurgical ways to address surgical management, then we can refer you orthopedic issues. to one of our orthopedic surgical colleagues.

“I really enjoyed learning OMT, or osteo- Oftentimes, we’re really the best place to start pathic manipulative therapy, and it’s some- if it isn’t going to be something major.” thing that I still utilize in my practice and with That may be a male patient who just wants my student athletes in the training room,” she to be able to walk his daughter down the aisle, says. “I think it’s become a really useful tool or an older female patient who wants to play to be able to offer this type of treatment to with her grandchildren. Naylor says that she

way to address an orthopedic treatment isn’t to immediately turn to surgery, say Baptist Health Sports Medicine physicians.

From treating the whole patient to using new techniques and treatments, there are nonsurgical ways to address orthopedic issues.

Kathleen Naylor, DO, sports medicine specialist with Baptist Health Sports Medicine, says she looks to nonsurgical options first.

How to best treat orthopedic injuries often comes from listening to her patients first, and then treating the whole patient.

This allows her to look beyond the injury, she says, to come up with treatments where surgery isn’t the first option.

“If you’re looking at an athlete and you’re looking at their recovery from an injury… when you build in that primary care component, you’re able to address all of the health issues or concerns that might be affecting how an athlete is able to perform in their sport,” says Naylor. “So you’re not just looking at an orthopedic injury; you can look at their diet, their nutrition, their mental health, their sleep, all of the things that might come into play. Even address things like if they have a cold, if they’re having issues with their blood pressure, what medications are safe for them to take. So, it really does help provide full-picture and wholebody care for an athlete all from one location.”

Naylor grew up in Florida as an athlete and academic achiever. A basketball and softball player through high school, Naylor shifted her focus to academics during her undergraduate time studying exercise physiology at the University of Miami. After studying osteopathic medicine at Kirksville College in Kirksville, Missouri, Naylor did a family medicine residency and sports medicine fellowship at University Hospitals in Cleveland, Ohio.

26 MD-UPDATE

PHOTOS BY ALEXANDRA ROGERS

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Orthopedics:Nonsurgical Orthopedics

is able to look at the how the patient’s body moves, what symptoms they are feeling and some of the side effects that they are experiencing from either an injury or medications.

She then designs a treatment plan that will help them arrive at the best outcome.

Meet William A. “Chance” Davis, DO For William “Chance” Davis, DO, a physician with Baptist Health Floyd Sports Medicine in New Albany, Indiana, one of the most promising new nonsurgical treatment plans is platelet rich plasma, or PRP. Essentially, he says, it’s a treatment where doctors take a patient’s blood, spin it down in a centrifuge and Sports have always been a remove the blood cells, big part of Dr. Davis’s life. leaving only platelets. As the platelets house the William “Chance” Davis, DO, “It is leaps and bounds ahead of physician with Baptist Health entirety of the response its time,” says Davis. “Doctors are Floyd Sports Medicine in New from your immune sysdoing fantastic things with PRP and Albany, Indiana. tem, they help the body getting athletes back onto the field to heal itself. with ligament and muscle tears.”

“Previously, if someone had a rotator cuff Although the technology has been around tear in their shoulder and one of the tendons for more than a dozen years, it is a therapy had a 50 percent tear, that’s not quite enough that is just now gaining ground, says Davis. to need surgical intervention,” he says. “Before, As more insurance companies are asking for all we had was anti-inflammatory medicines to information about the procedure and agreeing prevent it from hurting. We’d get the patient to cover it, the sports medicine group is better into therapy to try and get them stronger in the able to provide the therapy to its patients.

50 percent that they had left.”

“The more we’re able to research, the more Davis, who grew up outside of Biloxi, we’re able to get those studies out there, the Mississippi, received his undergraduate degree more it will be accepted,” he says. “There are from the University of Mississippi before very few preliminary studies, with not quite going into osteopathic medicine at Pikeville enough patients to really prove PRP works College, in Kentucky. He did his residency and drive the point home. But those studies in family medicine back in Mississippi, but are coming.” moved to Indianapolis to practice family medicine for two years, where his wife Ashley Meet Michael Hughes, DO McNight, DO, did her anesthesia residency.

PRP therapy was first used in the NFL says When her residency was over, the two moved Michael Hughes, DO. to Louisville, where Davis did a sports medi“I think it started in 2008 with Hines cine fellowship at the University of Louisville Ward, former running back for the Pittsburgh before landing at Baptist Health.

Steelers. That kind of put it on the horizon for Using ultrasound technology, he says, he everyone like it was a miracle cure. Now, I’m can find where a muscle is torn and see on the here in Louisville, Kentucky, offering it every screen where to inject the PRP. day to patients,” says Hughes.

Dr. Hughes played basketball and baseball at DuPont Manual and Transylvania University.

Michael Hughes, DO, Baptist Health Sports Medicine.

A Louisville native, Hughes graduated from DuPont Manual High School and Transylvania University in Lexington before going to the West Virginia University School of Osteopathic Medicine. After his residency in family medicine in Rome, Georgia, he was able to come back home to Louisville and complete a primary care/sports medicine fellowship before taking a position at Baptist Health Sports Medicine.

The PRP option is great for patients who don’t want to have surgery, he says.

“I think, a great option. I have a conversation with patients. I even get consults where some orthopedist is saying, ‘Go see these guys for PRP.’” PRP is a good treatment for rotator cuff repairs, chronic tennis elbow, patellar tendonitis, Achilles tendonitis, plantar fasciitis, and others, says Hughes.

His patients range from 10 to 99, and PRP helps with everything from a young person training for an Ironman to an older patient with chronic injuries where his choice is to counsel patients to hold off on surgery as long as they can.

PHOTOS PROVIDED BY BAPTIST HEALTH, WILLIAM DAVIS, DO, AND MICHAEL HUGHES, DO

ISSUE #153 27

SPECIAL SECTION

Orthopedics:Nonsurgical Orthopedics

The only contraindication for PRP, he says, is a patient with a low platelet count.

“If you don’t have enough platelets to go around the body, then we’re not going to be able to do that therapy,” says Hughes. “I will talk about it with anybody, as long as the diagnosis makes sense to discuss.”

As a DO, however, he puts a lot of value on other nonsurgical treatments like losing weight and getting up to move, as well as using office-based ultrasound. “I utilize it primarily for guided injections for multiple reasons. At times, it’s from a referral from other specialists, such as orthopedic surgeons to help with surgical planning or to delay surgery if patients find significant pain relief from the injection they receive. There are several good studies in literature validating ultrasound use for viscosupplementation, commonly called gel shots.

“I think that’s where a lot of my intersection comes in— where patients are wanting

to become more active but they can’t get there because they have a knee that’s bothering them and it’s holding them back,” he says.

“Probably the biggest problem we have right now is our society’s inactivity and sedentary lifestyles.”

View from the Top “Overall, the vast majority of bone and joint complaints are not surgical in nature,” says Mark A. Puckett, MD, CAQSM, medical director, Baptist Health Sports Medicine.

He continues, “Our focus in nonsurgical primary care sports medicine is to treat those nonsurgical problems with excellence from start to finish—whether that is discussing injury prevention methods, intervening early for acute injuries, or stopping a pattern of long- term overuse. That also demands integrating well with our surgical colleagues when we encounter those conditions where

surgery is the best solution, and we are very fortunate to have a healthy team with mutual appreciation for our differing skills and Mark A. Puckett, MD, CAQSM, focus. medical director, Baptist Health “My goal as Sports Medicine. a program is that we are able to deliver the very best care to patients of all activity levels to help maintain long-term healthy lifestyles,” says Puckett.

Puckett received his medical degree from the UofL School of Medicine. He did both his family medicine residency and sports medicine fellowship at Self Regional Healthcare in Greenwood, South Carolina.

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28 MD-UPDATE

PHOTO PROVIDED BY BAPTIST HEALTH

Mental Wellness

Why You Don’t Need to Be a Perfect Mom The Power of ‘Good Enough’ Parenting

BY JAN ANDERSON, PSYD, LPCC

It was the last thing she expected to hear from a therapist.

DR. JAN: Maybe the best mother is the “good enough” mother.

CLIENT (frowning): Why would I want to be a good enough mother? That sounds… substandard.

DR. JAN: You’re right. It sounds below average, doesn’t it? I need a better way to say it.

CLIENT: “Good enough” sounds like I let myself off the hook and start slacking off. I can’t do that. I’m shaping a human being!

DR. JAN: I get it. Until you’ve done it yourself, you don’t realize the pressure to bring your A-game. There’s no off-season. The responsibility that comes with motherhood is uniquely intense. But here’s the thing: When you talk about being a good mother, it sounds like you mean a perfect mother. I get a picture of an idealized myth of awesomeness beyond human capability. No wonder you’re stressed out.

Your Brain under the Influence of Perfectionism DR. JAN: Perfectionism tends to make you overthink, try too hard, and underperform. It’s crazy — perfectionism makes you more likely to screw up!

CLIENT: I see what you mean…

DR. JAN: You think, “Oh no, I screwed up.”

Now you try even harder.

CLIENT: That’s right!

DR. JAN: There’s even a scientific term for it. It’s called “reinvestment strategy.” It’s attempting to cope with your screwup by increasing your effort. Numerous studies show trying harder at this point only intensifies anxiety and stress — which can lead you to do worse. It’s what happens to your brain under the influence of perfectionism — like when you ingest too much social media or too many parenting books.

Mom Guilt In the digital age, the ideal of the Perfect Mother flourishes, fueled by glossy Instagram photos and meticulously curated Facebook posts. These cultural artifacts suggest that the Good Mother is a paragon of virtue: always patient, selfless, and emotionally available.

This time-honored myth insists that mothers conceal fatigue, suppress frustration, and continuously sacrifice their needs for the sake of their children.

In the 1990s, the trend toward “intensive parenting” kicked up the myth of the Good Mother several notches. This hands-on parenting model — an all-out investment, financially and emotionally, in your children — ushered in the shift to the “child-centered” society we now inhabit.

According to researchers at Cornell University, intensive parenting has become the aspirational ideal across all races and classes in American society — even for parents who can’t

afford the significant time and money required to pull it off.

Some mental health professionals and parenting experts are nudging the cultural narrative toward parenting approaches that reduce the stigma around normal parenting struggles, take less of a toll on a mother’s mental health, and promote resilience in her children.

The radical concept of the “good enough mother” isn’t a new parenting trend. British pediatrician and psychoanalyst D.W. Winnicott argued that the ideal of the perfect mother wasn’t beneficial for children.

Instead, Winnicott suggested that the goal is to raise individuals with the resilience to thrive in an imperfect world while liberating mothers from unproductive guilt and the relentless pressure to perform flawlessly.

It’s a hard sell.

There’s Something Even Better Than Perfect Promoting sustainable parenting practices that align with the reality of our human limitations isn’t sexy, but I’m finding ways to move the needle.

DR. JAN: What if I told you there’s something even better than the Perfect Mother?

CLIENT: Wait, what? How is that even possible?

DR. JAN: It’s true. There’s something even better than the Perfect Mother. We’re enchanted with the idealized Good Mother because we think it’s the highest and best. We think of perfect as “whole” or “complete.” So, to stop aiming for perfection seems like we’re settling for something less. That’s not true. A few things are missing even from the Perfect Mother’s parenting toolkit.

CLIENT: Really… What do you mean?

DR. JAN: For starters, when you’re in Perfect Mother mindset, it’s incredibly painful when you secretly feel something less than perfect ISSUE #153 29

Mental Wellness

or you perform less than perfectly. Normal parenting struggles can send you into a shame spiral that’s distracting and unproductive. That makes it hard to bounce back quickly and get back on track.

CLIENT: I can relate to that.

DR. JAN: Perfectionism is focused more on performance than connection. It reminds me of how organizational psychologists say there are three types of orientations in the workforce: 1) Task-oriented. 2) Rules-oriented. 3) People-oriented. All three of them are needed to make an organization successful. The Perfect Mother mindset tends to over-focus on tasks and rules, and in the process, it’s easy to lose the felt connection with yourself and your child.

CLIENT: That’s interesting. I hadn’t thought of it that way. But I don’t know… it feels weird.

What if I lose my edge and end up a wine mom or something?

DR. JAN: That’s a natural and very appropriate concern. My job is to show you how letting go of the Perfect Mother ideal does not mean you’re at risk of automatically swinging to the other extreme — the Bad Mother.

Breaking Free from the Myth of the Perfect Mother DR. JAN: Let’s start with a question: What are the worst things someone could say about you as a mother? Tell me everything that comes to mind.

CLIENT: The worst thing someone could say about me is that I don’t care about my kids.

That I’m selfish.

DR. JAN: Okay, what else?

We quickly identified CLIENT’S definition of the two extremes of Bad Mother and Perfect Mother. (Fig. A) Then came the more challenging part.

DR. JAN: I hope that by looking at these two polar opposites, you get a sense that there’s a Door #3.

CLIENT: I do… but I have no idea what it might look like.

DR. JAN: That’s understandable. It’s a different way of thinking when you’re no longer forced to choose between two either/or extremes. It’s called both/and thinking, and here’s the best part: When you open Door #3, it will feel even better than the brief moments when you picked Door #2.

Fig. A DOOR #1: The Bad Mother The Worst Thing Someone Could Say about You.

Fig. B DOOR #2: The Perfect Mother The Idealized Myth of Unsustainable Awesomeness.

• A bad mother is a disorganized, • A good mother tries to distracted mess. never show fatigue.

• She’s lazy. She’s always tired.

• Hardworking. Responsible.

• She’s a slacker who can’t keep up. Organized.

• She makes mothering look easy and effortless.

• A bad mother is always stressed out.

• She’s uptight, impatient, and easily freaked out.

• A good mother tries to never show frustration.

• She stays calm.

• A good mother is always encouraging and supportive.

• A bad mother is selfish: • She doesn’t care about her kids.

• A bad mother always puts her own needs before her child.

• A good mother is loving: • She’s always “present” and emotionally available.

• A good mother always puts her child’s needs before her own.

30 MD-UPDATE

CLIENT: (confused expression) How is that possible?

DR. JAN: I think it’s because, on some level, we sense that insanely perfect just isn’t real or sustainable. You can’t trust it or relax into it. In contrast, Door #3 makes room for your humanity. It’s more whole and complete than perfectionism because it makes room for all of you.

CLIENT: That’s interesting.

DR. JAN: When you pick Door #2, the Perfect Mother mindset has zero tolerance for screwups or underperforming. The bar is stratospherically high. Maybe the hardest part is that it’s so unforgiving when you screw up, whether you intended to or not. There’s a major Inner Critic that hangs out at Door #2.

In our next session, CLIENT and I applied both/and thinking to create what she called “The Good Mother, Redefined.” (Fig. B) Like many things in life, being a good mother involves balancing two equally important needs: attending to your own needs while caring for others. See if you feel better and function better when choosing a Door #3 mindset. Contact me if you want to jumpstart the process at LifeWise@DrJanAnderson.com or 502.426.1616.

DOOR #1: The Bad Mother

DOOR #2: The Perfect Mother (formerly known as Good Mother)

DOOR #3: The Good Mother, Redefined

Indifferent.

Unsustainable.

Sustainable.

• Motherhood is a walk in the park.

• It’s no big deal.

• You model negligence.

• Motherhood is a sprint. • Motherhood is a • Every day is like the marathon.

Olympics.

• How do I recover • You model fragility and quickly and get back rigidity. on track when life doesn’t go perfectly for me or my child?

• You model resilience.

• I count. You don’t count.

• Models self-absorbed.

• You teach your child not to expect much.

• You count. I don’t count.

• Models selfdeprivation and selfsacrifice.

• You teach your child that the world revolves around them.

• You count. I count, too.

• Models self-care as essential, not selfish.

• You teach your child how to hack it in the real world: the ability to tolerate and manage frustration, soothe themselves, and become selfsufficient.

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Commonwealth Pain & Spine Breaks Ground on New Ambulatory Surgery Center in New Albany NEW ALBANY On July 29,

2024, Commonwealth Pain & Spine, a leading provider of comprehensive pain management, held a groundbreaking ceremony of its new ambulatory surgery center (ASC) in New Albany, in partnership with ABEL Members of ABEL Construction and Commonwealth Pain & Spine took place in a groundbreaking celebration for the new Construction Company, CP& S ambulatory surgery center. Pictured are (l-r) Scott Kittle, project manager (ABEL), Mitchell Abel, VP of business develLLC. The state-of-the-art opment (ABEL), Phil Ryan, relationship manager (Stock Yards Bank & Trust), Jeff Ellison, CEO (CP&S), Janet Carlson, executive ASC will provide innovative, director of ASCs (CP&S), Elaina Turner, ASC administrator (CP&S), Jeff Gahan, mayor of New Albany, Justin Baker, principle accessible, and high-quality broker/partner (TRIO), Michael Tabor, partner (TRIO), Seth Edens, partner (TRIO). care to the region.

The 15,000 square foot ASC will be located You have never really lived until you have done something on Technology Ave in the Purdue Research for someone who can never repay you. — Paul Bunyan Park and is projected to open in 2025. The facility will have four operating rooms and two procedure rooms.

“We are thrilled to break ground on our new ambulatory surgery center. This facility will allow us to expand our services and continue providing best-in-class care to our patients in New Albany,” said Janet Carlson, executive director of ASC operations at Commonwealth Pain & Spine. “Our commitment to innovative surgical solutions and patient-centered Surgery on Sunday is a nonprofit that provides care remains our top priority.” monthly FREE outpatient surgeries to people in need.

This ASC will prioritize efficient and WE NEED: Made possible by 40-60 clinical and other volunteers cost-effective surgical experiences for patients • Surgeons with high-quality care. It will also provide a • Anesthesiologists • CRNAs wide array of innovative and safe treatment • OR Nurses options, backed by clinical research and evi• PACU Nurses dence-based best practices.

• Preop Nurses “ABEL is glad to be working with the team Volunteer Application • Surgical Technicians at Commonwealth Pain & Spine on a facility ONE SUNDAY A MONTH Make new friends that will bring cutting-edge and effective treathttps://redcap.link/SOSVolunteer while changing lives! ment to the citizens of Louisville and Southern Indiana,” said Mitchell Abel, vice president of This ad provided by D. Scott Neal, Inc. (dsneal.com) business development at ABEL. PHOTO PROVIDED BY COMMONWEALTH PAIN & SPINE

ISSUE #153 31

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Dr. Ben Kibler Receives Award from Kentucky Medical Association LEXINGTON Ben Kibler, MD, FACSM, has

received the Community Service Award from the Kentucky Medical Association (KMA).

The award recognizes one physician in Kentucky for significant contributions to the community. The KMA selected Kibler for his longtime dedication and service to athletes.

Kibler practiced orthopedic surgery at Lexington Clinic from 1977 to 2020 and is currently the medical director for the Lexington Clinic Institute for Clinical Outcomes and Research. In addition to authoring more than a dozen books and publishing more than 220 peer-reviewed papers, Kibler has received numerous awards and has served as a guest speaker at medical meetings in dozens of countries on every continent except Antarctica.

A former basketball player himself, Kibler

was the driving force behind Lexington Clinic creating its Orthopedics – Sports Medicine center, which has treated thousands of athletes and other patients’ orthopedic injuries. Among his many accomplishments at the Clinic, Kibler developed the first comprehensive sports medicine program in Kentucky and performed more than 23,000 surgical procedures.

Kibler was also a member of the KMA’s Committee on the Medical Aspects of Sport.

Some of the policies established by the committee during Kibler’s time include placing athletic trainers in every high school in Kentucky; determining safety plans for games in severe weather; and creating policies for

Ben Kibler, MD, FACSM

concussions, including how to recognize them and how to determine when players should be removed and allowed to return to play.

AT T O R N E Y S KEN TUCKY | TENNESSEE

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Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.COM 32 MD-UPDATE

PHOTO PROVIDED BY LEXINGTON CLINIC

We get patients back in the game of life faster.

The UofL Health Orthopedic team are the go-to experts for advanced, tailored treatment plans with less recovery time.

In fact, we lead the state in robotic surgical procedures that can minimize pain and improve quality of life in record time.

We are renowned for high-level care and customized surgeries that treat everything from the most complex fractures and joint replacements to minor injuries. Patients receive the highestlevel orthopedic care from shoulders to toes, including spines.

Our specialties include: Robotic Joint Replacement Hip Preservation Trauma Back & Spine Procedures Shoulder & Elbow Injuries Foot & Ankle Injuries Orthopedic Oncology At the forefront of minimally invasive surgery, our surgeons train other doctors, and are professors and researchers at the University of Louisville School of Medicine. We don’t just practice the latest leading techniques; we innovate and teach cutting-edge medical advancements.

As the official health care provider for UofL Athletics, we will provide that same expert VIP care to every one of your patients.

Visit UofLHealth.org.

Call 502-588-4888 to refer your patient today.

THAT’S THE POWER OF U Official Health Care Provider of the Louisville Cardinals

Rodolfo Zamora, MD Orthopedic Surgeon